Mindfulness-Based Cognitive Therapy provides better outcome than CBT: JAMA

A new study published in the Journal of American Medical Association Psychiatry suggests that adults in primary care settings should frequently be administered mindfulness-based cognitive therapy self-help (MBCT-SH) for mild to moderate depression.

Adults with mild to moderate depression should follow treatment guidelines that call for cognitive behavioral therapy self-help (CBT-SH), however dropout rates are significant. Different strategies are needed. In order to find out if practitioner-supported MBCT-SH is more effective than practitioner-supported CBT-SH at lowering depressive symptom severity in patients with mild to moderate depression at 16 weeks postrandomization, Clara Strauss and team conducted this study. They also looked at whether practitioner-supported MBCT-SH is more cost-effective than practitioner-supported CBT-SH.

This study compared the effectiveness of practitioner-supported MBCT-SH and practitioner-supported CBT-SH for adults with mild to moderate depression. It was an assessor- and participant-blinded superiority randomized clinical trial with 1:1 automated online allocation stratified by center and depression severity. Ten publicly funded psychological treatment services in England participated in the study (Improving Access to Psychological Therapies [IAPT]). 410 out of a total of 600 clients receiving IAPT services had their eligibility determined. Participants had mild to severe depression, according to diagnostic standards. Data was examined between January and October 2021. Patient Health Questionnaire (PHQ-9) score at 16 weeks after randomization was the preregistered main outcome. Intention-to-treat analysis with masked treatment arms was used as the main analysis.

The key findings of this study were;

The median (IQR) age of the 410 randomized participants was 32 (25-45), and 255 (62.2%) of them were female. 

When compared to practitioner-supported CBT-SH, practitioner-supported MBCT-SH significantly reduced the intensity of depressive symptoms at 16 weeks postrandomization, with a between-group difference of 1.5 PHQ-9 points. 

Almost 95% of the time, MBCT-SH outperformed CBT-SH in terms of cost-effectiveness. 

Yet, although being in the anticipated direction, between-group impacts on secondary outcomes were largely nonsignificant. 

Three significant adverse events that were all judged unrelated to the research were recorded.

In this randomized clinical study, practitioner-supported MBCT-SH outperformed practitioner-supported CBT-SH as the recommended treatment for moderate to mild depression in terms of clinical efficacy and financial efficiency.

Reference: 

Strauss, C., Bibby-Jones, A.-M., Jones, F., Byford, S., Heslin, M., Parry, G., Barkham, M., Lea, L., Crane, R., de Visser, R., Arbon, A., Rosten, C., & Cavanagh, K. (2023). Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression. In JAMA Psychiatry. American Medical Association (AMA). https://doi.org/10.1001/jamapsychiatry.2023.0222